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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY} OWNER INFORMATION <br /> ICS USE ONLY' ` <br /> OWNER ka l IT2. �`\Yuf`g Q onln District <br /> OWNER ADDRESS (N�u ber,Street,City,State,Zip) <br /> 9 <br /> ` P ermtttet use? <br /> PHONE E-MAILADDRESS <br /> (p a -513 - �o�/ ❑ zoning ,s,CUP, <br /> AGENT INFORMATION CONTRACTOR INFORMATION De estnctton;CAM, <br /> AGENT NAME CONTRACTOR NAM <br /> �anance(# )` <br /> A E 1 ADDRESS CON RACTOR ADDRESS C� ® Ite Plan Etrawn•tQ SCaI <br /> �+4� l (� 5'4 '- '�.��// Sd�c �! 'kandtncludesdtnTenslons <br /> (City,State,Zip) (Ci State,Zip) r <br /> " II( rh l t-V 5-3 7 aS �1IE ICI including location <br /> PHONE PHO E ` 41A lllSep-C <br /> 6a�_ .s7 CS-7C---- <br /> E-MAIL ADDRESS <br /> E-MAILADDRESSbacks' <br /> l <br /> sP ,� <br /> S <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Site Plan royal from I.PARENT PARCEL NUMBER: ZONING:(http://accessdane.co.daAnceR.E7GLErn <br /> etownsl'u p. <br /> ❑ NUMBER D`�/�_13.}.S�'l>a,7 �x <br /> TOWNSHI S CTION: ` .r � <br /> tlr�ew ts�n•,pocics <br /> ADDRESS: _ i <br /> �y I `� 1 [, ,,o,v 1 F or lans to stale <br /> �Q P <br /> CSM: LOT SUBDIVISIO 1� B OCWLOT � <br /> e attbn'ofprop� <br /> PROPOSED PROJECT INFORMATION � ro tag�e drawn to sgale <br /> PROD T DESCRIP�Imo: /�t� 11 d Z <br /> dl��'�1 � rive' `,ermtts <br /> ❑This project is a new buildin or structure. ''ate,county,town) <br /> This project is an addition/alteration to an existing building or structure. `g <br /> anttarrerrn is <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> (pttlalt �►rtkralte <br /> ❑SEWER SEPTIC . V ``� 70 <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> �./ r C3�etland�load alnf f <br /> / .,,..K.4-01.0-0,0_:-`fir.:,,,,:::-.7-7.Z.,,5:1:14:4'aar hmet <br /> AREATO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> • fErosto��tro�permll <br /> BASEMENT: �e 1 ST FLOOR a <br /> j TOTAL SQUARE FOOTAGE: j (slQpelstt�rbare; <br /> Iirlingfa ss)r : <br /> 2ND FLOOR: 3RD FLOOR: / / /( ' <br /> I �l( ,c) <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ —I. <br /> r--- `- a 'aitable optiions <br /> (Please round to nearest dollar) 5 no n <br /> Z <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? El �[No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes �No ❑Don't know <br /> 3. Have you talked with the township about your project? .Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes o <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes No Don't know <br /> 7. Is this correcting a violation? ❑YesNo <br /> j>1 <br /> I APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ •-►' <br /> 545112(1108) <br />